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NCLEX Review > Fundamentals for Nursing > Flashcards

Fundamentals for Nursing Flashcards

1
Q

Seizure precautions

A

roll client to the side with head flexed slightly forward. do not put anything in mouth. loosen restrictive clothing,

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2
Q

Fire - Race

A

Rescue, Alarm, Contain, Extinguish

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3
Q

Fire - PASS

A

Pull, Aim, Squeeze, sweep

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4
Q

ABC - order of people to remove in case of fire

A

A: ambulatory B: bedridden C: critical

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5
Q

Equipment

A

use of extension cords are not permitted in any client care area, never handle any radioactive agent with bare hands

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6
Q

transferring client from bed to chair or chair to bed

A

position the bed or chair so that the client is moving toward the strong side.

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7
Q

HOB 30 - gastric feedings, head injury, post op cranial surgery, respiratory illness with dyspnea, post op cataract removal, ICP

A

semi fowlers

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8
Q

HOB 45 - head injury, post op cranial surgery, post op abdominal surgery, respiratory illness or cardiac problems with dyspnea, bleeding esophageal varicose, post op thyroidectomy, or cataract removal, ICP

A

fowlers

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9
Q

HOB 90 - respiratory with dyspnea, emphysema, status asthmatics, pneuothorax, cardiac problems with dyspnea, feeding, meal times, hiatal hernia, during and after meals

A

high fowlers

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10
Q

lying on back, head and shoulders slightly elevated with small pillow - spinal cord injury (no pillow)

A

supine

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11
Q

lying on abdomen, legs extended and head turned to side - client who is immobilized o unconscious, post lumbar puncture 6-12 hours, post myelogram 12 to 24 hours, post op tonsillectomy and adenoidectomy

A

prone

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12
Q

lying on side with most of body wight borne by the lateral aspect of the lower ilium - post abdominal sugary, unconscious, seizures(head to side) post op tonsillectomy and adenoidectomy, post op pyloric stenosis of the lower scapula and the lateral (right side) post lier biopsy, rectal irrigations

A

Lateral - side lying

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13
Q

lying on left side with most of body weight borne by the anterior aspect of the ilium, humerus and clavicle - unconscious, enemas

A

Sims (semi prone)

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14
Q

lying on back with hips and knees flexed at right angles and feet in stirrups - perineal, rectal, and vaginal procedures

A

lithotomy

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15
Q

head and body lowered while feet are elevated - some surgeries; during labor if umbilical cord pressure is trying to be relieved

A

trendelenburg

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16
Q

supine with legs elevated - shock

A

modified trendelenburg

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17
Q

head elated while feet are lowered - cervical traction; to feed clients restricted to supine position such as post cardiac cath

A

reverse trendelenburg

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18
Q

elevate legs feet or arms/hands by adjusting or supporting with pillows - throbophelbitis, application of cast, edema, postop surgical procedure on extremity

A

elevate one or more extremities

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19
Q

supine with knees flexed - urinary cath of female, abdominal assessment, abdominal wound evisceration

A

Dorsal recumbent

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20
Q

correct fit of crutches

A

2-3 finger widths between the axilla and top of the crutch

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21
Q

Crutches non weight bearing

A

begin in tripod position maintain weight on “unaffected” extremity. advance both crutches and affected extremity. move unaffected leg forward (beyond crutches) advance both crutches and then the affected leg

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22
Q

Crutches: weight bearing

A

move crutches forward about one steps length, move affected leg forward level with crutch tips, move unaffected leg

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23
Q

walking up stairs with crutches

A

unaffected leg goes up first and the crutches move with the affected leg

24
Q

walking down stairs

A

affected leg goes down first and the crutches move with the affected leg

25
Q

cane

A

used on the unaffected side, move the affected side and cane at the same time

26
Q

walker

A

advance walker 12 inches, advance with affected lower limb, move unaffected limb

27
Q

Chain of infection

A

causative agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host

28
Q

medical asepsis

A

clean technique

29
Q

surgical asepsis

A

sterile technique

30
Q

Standard precautions (tier one) PPE used

A

all body fluids, non intact skin and mucous membranes. PPE - gloves, gown, goggles - clean spills with a solution of bleach and water (1:10 dilution)

31
Q

Airborne Precautions - PPE used

A

Airborne precautions - (measles, varicella, pulmonary or laryngeal TB) PPE used - mask(N95 for TB) gloves, goggles prn

32
Q

Droplet precautions - PPE

A

streptococcal pharyngitis, pneumonia, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia/sepsis, pneumonic plague - Mask and standard precautions

33
Q

Contact precautions - PPE

A

spread by direct or indirect contact. wound drainage, fecal incontinece, or other bodily discharges that suggest an increased potential for environmental contamination and risk of transmission. PPE - gloves, gown; PRN used of mask and goggles and standard precautions

34
Q

Order of PPE application

A

Gown, Mask, goggles/face shield, gloves

35
Q

Order of PPE removal

A

Gloves, goggles/face shield, gown, mask

36
Q

AIDS/HIV precautions required

A

standard - duration of illness

37
Q

Chicken pox (varicella) precautions required

A

Standard/airborne/contact - until lesion crust over

38
Q

Clostridium difficile precautions required

A

standard/contact - duration of illness

39
Q

Hepatitis A

A

standard/contact if client has fecal incontinece - until 7 days after onset of jaundice

40
Q

Hep B

A

standard - duration of illness

41
Q

Hep C

A

standard - additional precautions specific to hemodialysis unit

42
Q

Herpes simplex

A

standard/contact - until lesions crust over

43
Q

carbapenem - resistent enterobacteriaceae (CRE)

A

standard/contact -

44
Q

herpes zoster (shingles)

A

standard/airborne/contact - duration of illness or with visible lesions

45
Q

Measles (rubeola virus)

A

standard/airborne - duration of illness - virus can live on affected surface for up to 2 hours

46
Q

meningococcal disease

A

standard/dropplet - until 24 hr therapy continuous

47
Q

MRSA

A

standard/contact - duration of illness -

48
Q

pneumonia

A

standard/dropplet - until culture is negative

49
Q

respiratory syncytial virus

A

standard/contact/droplet - duration of illness

50
Q

Rotavirus

A

standard/contact - duration of illness - feces

51
Q

Rubella

A

standard/droplet - 7 days after onset of rash

52
Q

salmonella

A

standard/contact - duration - feces

53
Q

shigellosis (dysentery)

A

standard/contact - duration - feces

54
Q

staphylococcus aureus

A

standard/contact - duration - body fluids

55
Q

TB

A

standard/airborne - ntil three sputum smears are negative on consecutive dye or TB is ruled out -

56
Q

Vancomycin resistant enterococci (VRE)

A

standard/contact - until three negative cultures from infectious site (1 week apart) - stool body sites from which VRE is isolated

NCLEX Review (16 decks)

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